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Running head: ADOLESCENT MINDFULNESS GROUPS 1

Group Mindfulness Programs for Adolescent Emotional Regulation and Stress Management

A Literature Review

Presented to

The Faculty of the Adler Graduate School

_____________________

In Partial Fulfillment of the Requirement for

The Degree of Master of Arts in

Adlerian Counseling and Psychotherapy

______________________

By

Michelle M. Ashmun

Chair: Meg Whiston, Ph.D

Reader: Nikki Marchand, MLIS

_____________________

May 2019

ADOLESCENT MINDFULNESS GROUPS 2


Copyright © 2019

Michelle M. Ashmun

All rights reserved


Abstract

Adolescence is a time of several cognitive developmental changes and new life experiences that

increase the potential for stress, negative emotions, and emotional dysregulation. Research on

changes in brain structure and function during adolescence offers insight into reasons for

increased risks for stress and emotional challenges. Experiencing stress and recurrent negative

emotions can have wide-ranging consequences in adolescents’ lives and mental health. Teaching

adolescents how to manage emotions and stress can improve their academic performance, health,

and overall functioning. Research has demonstrated that mindfulness and mindful breathing are

effective methods for managing stress and emotions, and teaching mindfulness to adolescents in

classroom lessons and school-based groups is similarly effective. Adolescents who have

participated in these programs reported they enjoyed the programs, found them useful, and noted

beneficial mental, emotional, and behavioral results. Research for how these programs address

diversity is still in early stages of development.

Keywords: adolescence, mindfulness, emotion regulation, stress management


Acknowledgments

With great respect, honor, and gratitude, I thank Sifu Ray Hayward, Grandmaster Wai Lun Choi,

and Paul Magee for their inspiration, wisdom, expertise, role modeling, encouragement, support,

effort, generosity, and kindness.

With relief and gratitude, I thank Meg Whiston for stepping in to serve as chair for my master’s

project committee, Nikki Marchand to serve as my reader, and Michael Grohs to serve as writing

consultant. I appreciate your willingness to provide your time, expertise, understanding, and

support in completing this project.


Dedication

I dedicate this effort and outcome to Marty: consummate gentleman, punk fan, opera

appreciator, pun slinger, port connoisseur, stellar friend, caring listener, steadfast supporter,

deeply generous giver, heron lover, wisdom seeker, tai chi student, dedicated Northwest. He is

profoundly missed.


Table of Contents

Stress, Emotions, and Adolescents ................................................................................................. 8

Prevalence and Reasons for Stress .............................................................................................. 8

Emotion Regulation .................................................................................................................. 12

Mindfulness, Meditation, and Mindful Breathing ........................................................................ 13

Mindfulness and Meditation Definitions .................................................................................. 13

Breathing and Emotions ............................................................................................................ 13

Diaphragmatic breathing. .................................................................................................. 14

Potential counterproductive effect of breathing patterns. ................................................. 15

Sighing. ............................................................................................................................. 15

Beneficial Aspects of Mindfulness Meditation......................................................................... 16

Improved attention and awareness. ................................................................................... 16

Reduced reactivity and negative behaviors....................................................................... 17

Mindfulness Programs .................................................................................................................. 19

Modifications for the Adolescent Developmental Stage .......................................................... 19

Trauma-Informed Approach ..................................................................................................... 20

Mindfulness Training for Emotional Regulation ...................................................................... 21

Mindfulness Meditation Group in Alternative High School..................................................... 23

Peer-Led Mindfulness Training with Adolescents ................................................................... 24

Mindfulness Groups for Latino Adolescents ............................................................................ 26

Mindfulness Program at Park Middle School ........................................................................... 28

Mindfulness for Children from Lower Socioeconomic Backgrounds ...................................... 30

The Adlerian Individual Psychology Perspective ......................................................................... 34

The Nature and Purpose of Emotions ....................................................................................... 34

Adlerian View of Confidence ................................................................................................... 35

Adolescence, inferiority feelings, safeguarding, and striving. .......................................... 37

Mindfulness within the Context of Individual Psychology ...................................................... 38

Discussion ..................................................................................................................................... 40

Implications for Practice ........................................................................................................... 40

Recommendations for Future Research .................................................................................... 42

Conclusion .................................................................................................................................... 43

References ..................................................................................................................................... 45



Adolescence may be a time of increased stress and negative moods. The American

Psychological Association (APA; 2013) conducted a survey of 1,018 adolescents who reported

an average stress level of about 6 on a ten-point scale. Likewise, Larson and Lampman-Petraitis

(1989) demonstrated that adolescents experienced an increase in negative emotions from fifth

grade to ninth grade. Neurological and physiological developments are a contributing factor to

adolescent stress and emotional challenges. Mezulis, Abramson, Hyde, and Hankin reported the

sympathetic and parasympathetic nervous systems have a decreased capacity to support

adolescents’ coping mechanisms and emotional regulation (as cited in Lanteigne, Flynn,

Eastabrook, & Hollenstein, 2014).

Given the emotional variability adolescents can experience, emotion regulation and stress

management become important assets for coping during adolescence. Research by Greene and

Walker and by Gross (1998) illustrated emotion regulation can help prevent or mitigate negative

emotions, stress, and problematic behavior (as cited in Metz et al., 2013). Mindfulness, and

especially mindful breathing, have been demonstrated to be effective methods for stress

management and emotion regulation because of its overall calming effect on the brain, heart, and

other systems that can suppress negative emotions and stress (Jerath, Crawford, Barnes, &

Harden, 2015). An exploration of Adlerian concepts can further illuminate how mindfulness can

be useful for adolescent emotion regulation and stress management. According to Adlerian

concepts, adolescents can choose how they perceive and respond to situations; their perceptions

then determine their stress levels and emotions, which can be beneficial or detrimental (as cited

in Dewey, 1984). Mindfulness can be used to objectively consider whether or not one’s

responses are constructive, to cope with uncomfortable feelings, and deliberately choose more


constructive responses; however, Apsche and Jennings found mindfulness meditation instruction

to be more effective for adolescents if it has been modified to accommodate their developmental

needs and interests (as cited in Jennings & Jennings, 2013). Six programs will be reviewed to

explore how group mindfulness training has been modified for adolescent participants and

implemented in a school setting. These programs vary according to the mode of instructional

delivery, the qualifications of the instructor, the length of the program, and the communities in

which they are situated. By reviewing these programs, one can also see implications for training,

research, and practice. Furthermore, one can see a gap in addressing issues in diversity such as

modifying needs to fit participants from a variety of cultural groups and tending to the needs of

participants who have experienced trauma.

Stress, Emotions, and Adolescents

Prevalence and Reasons for Stress

Stress, worry, and negative moods are commonplace in adolescents’ lives. The APA

(2013) conducted a survey of 1,018 adolescents between the ages of 13 and 17. On a ten-point

scale, adolescents reported an average stress level of 5.8, with 31% stating they felt

overwhelmed as a result of stress, and their amount of stress has grown within the last year. In

addition, 51% reported they have been told they seemed stressed, 26% relayed they were curt

with their peers, 40% experienced irritability or anger, and 36% experienced nervousness or

anxiousness. The results also indicated that adolescents value stress management, as 51%

expressed that stress management was a highly important practice (APA, 2013). The APA’s

survey illustrated adolescents experience stress that negatively affects their emotions and

interactions with others, and they consider stress management to be a worthwhile pursuit.


Adolescents experience stress for a number of reasons. Neff and McGehee noted

“academic performance, fitting in, body image issues, dating, and sex” as reasons for stress (as

cited in Edwards, Adams, Walkdo, Hadfield, & Biegel, 2014). The APA (2014) survey results

listed expectations for achievement, college admissions, and career planning as top reasons for

stress for adolescents. Several researchers have found additional reasons for stress, including

homework, tests, deadlines, interactions with teachers, conflicts with parents, and the stress of

balancing school, work, and friends (Gutman, Sameroff, & Cole; Jacobshagen, Rigotti, Semmer

& Mohr; Melman, Little, & Akin-Little; as cited in Broderick & Jennings, 2012). Moreover,

many of these stressors are new life experiences with adolescents undergoing many changes

during this time (Petersen & Taylor; Simmons, Burgeson, Carlton-Ford, & Blyth; as cited in

Larson & Ham, 1993). Indeed, the considerable number of changes alone can account for stress

during adolescence (Brooks-Gunn, Warren, & Rosso; Petersen & Hamburg; as cited in Larson &

Ham, 1993).

A study conducted by Larson and Lampman-Petraitis (1989) further illustrated the

negative emotions experienced during adolescence. Specifically, Larson and Lampman-Petraitis

were interested in determining if children’s average affect became more negative as they grew

into adolescents. They collaborated with 473 students between the ages of 9 and 15 to document

their daily emotional states (Larson & Lampman-Petraitis, 1989). The subjects were

predominantly European-American from lower-middle, middle, and upper-middle

socioeconomic classes. The students provided a rating of their emotions seven times a day over

the course of a week. They used rating scales provided by the researchers that conveyed their

levels of affects such as happiness, irritability, friendliness, alertness, and boredom. Larson and

Lampman-Petraitis (1989) found that the ninth graders used the most positive rating level only


half as frequently as the fifth graders. They also found that the older students used the

“moderately negative” rating levels more frequently. Larson and Lampman-Petraitis (1989)

concluded the older students had a lower, less positive emotional baseline in comparison to the

younger participants. This finding underscores the importance of teaching emotion regulation to

adolescent students.

In addition to change and stressors, neurological and physiological developments can

contribute to challenges during adolescence. For example, Hoffman, Cole, Martin, Tram, and

Seroczynski found the limbic part of the brain becomes more sensitive and reactive to perceived

threats, more negatively interprets facial expressions, and increases criticism of both self and

others (as cited in Lanteigne et al., 2014). According to Spear, adolescents tend to have an

“overexpression of and increased sensitivity to cortisol, the major stress hormone” (as cited in

Broderick & Jennings, 2012, p. 114). This cortisol sensitivity can cause adolescents to be more

prone to stress. Furthermore, researchers have noted particular sources of stress to which

adolescents are especially vulnerable. More specifically, Sumter, Bokhorsta, Miersa, Van Pelt,

and Westenberg found “perceived stress, mental anticipation of a stressor, and memories about

past stressors and peer rejection have particularly strong associations with cardiac and cortisol

reactivity among adolescents” (as cited in Broderick & Jennings, 2012, p. 114). These stressors

occur not only in the present reality but in the past, future, and in the imagination. These sources

of stress can add to the present real-life stressors with which adolescents must already cope.

Meanwhile, Mezulis, Abramson, Hyde, and Hankin depicted systems that mitigate heightened

stressed emotional states and support emotional regulation, such as the sympathetic and

parasympathetic nervous systems and hypothalamic-pituitary-adrenal axis, may not mature in a

coordinated manner to effectively support adolescents’ coping mechanisms, stress management,


and emotional regulation (as cited in Lanteigne et al., 2014). Overall, these varied physiological

changes can make coping with stress, change, and new experiences significantly more difficult

for adolescents.

Experiencing stress and recurrent negative emotions can have wide-ranging

consequences in adolescents’ lives. As McEwen asserted, “prolonged stress or dysregulated

responsiveness can have a negative effect on health, learning, and productivity” (as cited in

Broderick & Jennings, 2012, p. 114). For example, Edwards et al. (2014) cited the work of

Feindler; Neff & McGehee; Ommundsen & Vaglum; Prins & Hanewald, “Children feel the

negative impacts of stress, resulting in test anxiety, generalized anxiety, anger, and violent

behavior, and conduct disorders ()” (p. 245). Similarly, Arnsten and Shansky found that,

“Executive functions such as the ability to direct attention and solve problems efficiently show

clear stress-induced disruptions, particularly when there is a perceived lack of control over

stressors” (as cited in Broderick & Jennings, 2012, p. 114). The aspect of control is pertinent to

the developmental stage of adolescence, which simultaneously requires adults to control some

aspects of adolescents’ lives while adolescents strive to gain control over more aspects of their

own lives. In addition, stress can have a detrimental physiological effect on the brain, as there is

“ample evidence linking high levels of cortisol to reductions in brain volume and cell number,

particularly in the hippocampus. This structure is critical for learning new things” (Grisel,

Rasmussen, & Sperry, 2006, p. 409). Furthermore, Arnsten demonstrated “chronic emotional

stress has been shown to impair prefrontal cortex functions by reducing creativity, efficiency of

working memory, attentional control, and problem-solving capacities––precisely those functions

most necessary for effective learning” (as cited in Metz et al., 2013, p. 253). Stress and negative


emotions can physically impede adolescents’ capacity to learn, ability to function, and create

risks to adolescents’ health.

Emotion Regulation

Given the emotional variability adolescents can experience, emotion regulation becomes

an important tool for coping during adolescence. Best, Miller, and Jones defined emotion

regulation as “skills used to moderate affective experiences” (as cited in Metz et al., 2013, p.

253) while Eisenberg, Spinrad, and Eggum described emotion regulation as “strategies to

manage distress in order to meet the demands of different situations or achieve certain goals,

such as those involved in learning, and is…a foundation for well-being, academic achievement,

and positive adjustment” (as cited in Metz et al., 2013, p. 253). Emotion regulation is important

for adolescents’ academic performance, health, and overall functioning. Research by Greene and

Walker and by Gross (1998) illustrated emotion regulation can “serve as protective factors

against the emergence of psychosomatic symptoms and emotion and behavioral difficulties” (as

cited in Metz et al., 2013, p. 253). Furthermore, Wolff and Ollendick specified conditions

mitigated by emotion regulation to include anxiety, depression, self-injury, and substance abuse

(as cited in Metz et al. 2013). Emotion regulation is useful for both reacting to current situations

as well as proactively caring for one’s mental health. Rothbart and Sheese have further

described emotion regulation as including skills for “monitor[ing] attention” (as cited in Metz et

al., 2013, p. 253) and “identification and acceptance of emotional experiences, management of

distress and modulation of excitement, sustaining motivation, prioritizing among competing

goals, and adaptive adjustment of behavioral responses” (Broderick & Jennings, 2012, p. 114).

These aspects of emotion regulation make it especially pertinent to adolescents’ academic

performance and positive school engagement.


Mindfulness, Meditation, and Mindful Breathing

Mindfulness and Meditation Definitions

Mindfulness can be defined as “the practice of being with our experience, moment to

moment, without reflexively changing or dismissing it” (Kabat-Zinn, as cited in Broderick &

Frank, 2014, p. 31). In mindfulness, one chooses to pay attention to the present moment with an

attitude of acceptance. It is a mindset that can be cultivated and strengthened through practice.

A common way to practice mindfulness is through the method of mindfulness meditation, which

Miller, Fletcher, and Kabat-Zinn defined as “the effort to intentionally pay attention, non-

judgmentally, to present-moment experience and sustain this attention over time’’ (as cited in

Wisner & Norton, 2013, p. 211). During mindfulness meditation, one sets aside time to

deliberately and repeatedly refocus one’s mind on the current experience, avoiding becoming

captivated (or limiting the captivations) in thoughts of the past or future and refraining from

placing positive or negative values on it. A common technique to maintain attention on the

present experience is to focus on one’s experience of breathing. When the mind strays to the

past or future, one redirects the attention back to the breath. As a result, one strengthens the

ability to be mindful.

Breathing and Emotions

There is ample research that supports the connection between emotions and breathing.

Jerath et al. (2015) found that breathing has an overall calming effect on the brain, heart, and

hormones, such that it can physiologically influence these internal systems to suppress negative

emotions. More specifically, breathing influences processes such as attention, memory,

emotional appraisal and arousal, emotion regulation and expression, and empathetic

communication (Argyropoulos et al.; Beauchaine; Clow et al.; Pariante & Lightman; Porges;


Sargunaraj et al.; Stromberg et al.; van Honk et al., 1998, as cited in Ma et al., 2017).

Furthermore, Jerath et al. (2015) shared studies that demonstrated breathing techniques help

manage stress, support emotion regulation, and decrease both anxiety and depression. From

these studies, Jerath et al. (2015) found verification of the interconnection between breath and

emotion, which led them to conclude people have the capability to use breathing techniques to

modify their emotions and manage their stress. One way people can harness the breath to

support emotional regulation is by using calming breathing patterns, such as diaphragmatic

breathing.

Diaphragmatic breathing. Diaphragmatic breathing or “belly breathing” is a valuable

breathing method for stress management and emotional regulation. This method involves

deliberately expanding the abdomen during inhalation to breathe more deeply and slowly (Ma et

al., 2017). Specifically, people take an average of four breaths a minute while doing

diaphragmatic breathing as compared to 17 breaths a minute when breathing in a normal manner

while at rest (Ma et al., 2017). Correspondingly, physiological markers that indicate a well-

balanced, relaxed state coincides with a breathing rate of about 4.5–5.5 breaths per minute (Ma et

al., 2017). Multiple studies have explored the effects of diaphragmatic breathing. Chen et al.

conducted a study that measured anxiety before and after an 8-week program with adult subjects

using diaphragmatic breathing (as cited in Ma et al., 2017). Anxiety scores had decreased

significantly after the program. A different study conducted by Khng provided similar results

with elementary students who reported feeling less generalized and test anxiety than the control

group at the program’s conclusion (as cited in Ma et al., 2017). Another study compared

subjects’ experiences of several breath patterns that varied in depth and speed (Conrad et al.,

2007). Conrad et al. (2007) discovered that shallow breathing, whether fast or slow, increased


tension and anxious feelings in all subjects. Conversely, slow and diaphragmatic breathing

yielded increased relaxation in all subjects. These studies demonstrate the value of using

diaphragmatic breathing to reduce stress, tension, and anxiety.

Potential counterproductive effect of breathing patterns. While doing breathing

techniques is typically beneficial, many people experience it as challenging, and some may

experience it as counterproductive to relaxation. Multiple studies have explored subjects’

experiences of following prescribed breathing patterns. Subjects reported they experienced it as

challenging, uncomfortable, requiring additional effort, and increased their level of tension

(Conrad et al., 2007; Vlemincx, Van Diest, & Van den Bergh, 2012). Furthermore, some

individuals experienced their modified breathing as a hazard and became anxious (Conrad et al.;

von Leupoldt et al., as cited in Paulus, 2013; Vlemincx et al., 2012). Klein hypothesized the

cause of this anxiety was that the altered breathing pattern generated a message to the brain that

the person was suffocating (as cited in Conrad et al., 2007). As a result, it is crucial to be aware

that some mindfulness meditation participants may experience mindful breathing as oppositional

to relaxation goals. In this case, it would be fitting to instruct the student to forego the pattern

and breathe naturally.

Sighing. When utilizing breathing patterns, it can be helpful to investigate anomalies,

such as sighing. Researchers have connected sighing to three main circumstances. First, Hirose

found sighing correlated with participants’ feelings of tension, discomfort, and expending effort

while following imposed breathing patterns (as cited in Vlemincx et al., 2012). Vlemincx et al.

(2012) theorized these feelings may relate to participants’ lack of experience with following

prescribed breathing patterns. Their theory raises the question: would participants’ discomfort,

effort, and related sighing decrease as they gained further practice while participating in


additional sessions? The second circumstance correlated sighing with negative thoughts or

emotions. More specifically, Vlemincx et al. cited previous studies that found these emotions

included restlessness, unpleasant thoughts, negative affectivity, stress, and anxiety disorders.

According to Stevenson and Ripley, the third circumstance that corresponded to increased

sighing was when participants with anxiety were instructed to relax after experiencing tension

(as cited in Vlemincx et al., 2012). Sighing can therefore be an important indicator that

participants are experiencing the breathing pattern as effortful or experiencing negative thoughts

or emotions. While this last point may be more mundane, it is helpful to know that participants’

sighing may have a more neutral rather than negative cause. It may be interesting to note if

participants’ sighing decreases once they have relaxed from their previous tension and settled

into their mindful breathing session.

Beneficial Aspects of Mindfulness Meditation

There are aspects within the mindfulness meditation practice that can use further

elaboration, especially in how they support stress management and emotional regulation. These

benefits include improved awareness and attention and reduced negative behaviors.

Improved attention and awareness. Through mindfulness meditation, students learn to

pay attention to their thoughts, emotions, and breath in a new way. Learning to observe thoughts

and discern whether or not they are about the present moment creates a perspective of

objectivity. This is referred to as “decentered” awareness, where students become aware of the

nature of their thoughts but in a disengaged manner (Broderick & Frank, 2014, p. 33; Broderick

& Jennings, 2012). From this disconnected stance, students see that they have a choice of where

to place their attention and can choose to disengage from the current thought. In addition, they

realize just how many thoughts they have as well as how quickly thoughts pass and move on to


another thought. Students identify the transitory, fleeting nature of their thoughts. As a result,

uncomfortable thoughts and emotions may become more bearable because people come to

understand the thought will end soon, and they can turn attention away from the thought and

back to the breath. Similarly, “Uncomfortable thoughts and feelings are viewed as temporary

mental events that are allowed to exist without the need to challenge, change, or be captured by

them” (Metz et al., 2013, p. 255). Miller, Fletcher, and Kabat-Zinn found decentered awareness

can serve to “cultivate a stable and nonreactive present moment awareness’’ (as cited in Wisner

& Norton, 2013, p. 211). With mindfulness meditation practice, students can train their

attention, increase their awareness about their thoughts, and strengthen their resilience against

negative thoughts and emotions.

Reduced reactivity and negative behaviors. With a decentered awareness, skill in

shifting focus to the breath, and knowledge of the transitory nature of thoughts, students can see

they have choices in how they react to external events as well. Just as they have a choice

whether to continue thinking a thought, they can choose whether or not to act on it. Boyce

asserted “the practice of an attentive and nonreactive attitude toward one’s impulses may

‘increase the gap between impulse and action’” (as cited in Broderick & Jennings, 2012, p. 116)

and decrease reactivity (Sibinga et al., 2011). Decentering reduces the influence of the thought

and the urgency to act on that thought. Peterson further explained that by students noticing the

state of their breath, it gives them insight into their current emotional state, to notice if they are

upset, and take that into account before they automatically react (as cited in Coetsee, 2017). In

addition, the act of turning the attention to the breath, which is a neutral event, enables students

to interrupt their emotional reaction. As Carmody explained, by removing attention from the

event causing an emotional reaction, the student’s tension and other physical stress responses


decrease, and then his or her emotional reaction decreases (as cited in Tadlock-Marlo, 2011). He

or she is then better able to respond in a more objective and constructive manner (Tadlock-

Marlo, 2011).

Mindfulness meditation can have a cumulative beneficial influence over students’

thoughts, behaviors, and academic performance. For example, students can develop detrimental

patterns as coping mechanisms for stress, anger, anxiety, and boredom such as aggression,

procrastination, avoidance, or becoming excessively focused on stressful or emotionally-laden

events (Broderick & Jennings, 2012); however, mindfulness can help break these habitual

responses because it improves students’ insights into their thoughts and reactions to events

(Broderick & Jennings, 2012). Some studies have demonstrated that mindfulness training offers

students “increased well-being, decreased anxiety and worry, and decreased reactivity” (Sibinga

et al., 2011, p. 214). In addition, reductions in students’ reactivity can be observed through

behavioral data. Specifically, researchers have found that “meditation helps adolescents to

decrease rule violations, class absences, and days suspended from school” (Wisner & Norton,

2013, p. 211). By compiling behavioral data, schools can determine the effectiveness of mindful

meditation for the students.

Mindfulness training has also helped improve academic performance. As part of a post-

mindfulness training survey, students indicated they found it improved their ability to

concentrate on their homework and “explicitly mentioned meditating or doing breathing

exercises right before doing their homework or taking a test in order to reduce their stress”

(Sibinga et al., 2011, p. 216). As research has illustrated, mindfulness meditation increases

students’ ability to form more beneficial ways to respond to stress and challenging emotions.


Mindfulness Programs

Mindfulness meditation instruction was found by Apsche and Jennings to be more

effective for adolescents if it had been modified to accommodate their developmental needs (as

cited in Jennings & Jennings, 2013). In addition, each program has distinct characteristics, such

as their demographics, qualifications of instructors, or delivery methods. Each program will be

described according to its goal, the intervention used, the data-measurement tools, the subjects,

and the outcomes. These characteristics will be given further consideration in the final section.

Modifications for the Adolescent Developmental Stage

Apsche and Jennings have identified it is necessary to modify mindfulness training with

youth to accommodate their interests and developmental needs (as cited in Jennings & Jennings,

2013). Lee et al. and Semple et al. identified such developmental factors to include information

input, memory, and attention span (as cited in Tadlock-Marlo, 2011). More specifically, it is

helpful to reduce the session time and the session components such as lecture and meditation

practice time (Jennings & Jennings, 2013). In addition, session leaders may provide meditation

explanation and instruction in simplified terms and more concrete language (Sibinga et al.,

2011). For example, leading students in guided meditation instruction that relies heavily on

sensory imagination, such as guided imagery or tactile components, has been effective (Jennings

& Jennings, 2013; Tan & Martin, 2015). Additionally, Jennings and Jennings (2013) advised

instructors to “make mindfulness more fun and engaging by offering a variety of mindfulness

exercises and activities that have an innate appeal to youth, such as sports, nature, adventure, and

discovery” (p. 23). For example, students have responded positively to a guided meditation

focused on a trip to the beach and the sensory input that could be experienced there (Jennings &


Jennings, 2013). With these modifications, meditation instruction for youth is likely to be more

engaging and effective.

Trauma-Informed Approach

Of the six programs to be reviewed, only one acknowledged the potential

counterproductive effects of mindfulness meditation for some students; however, none of the

programs’ researchers mentioned whether or not mindfulness meditations may be inappropriate

for students who had experienced trauma. It is important to be conscientious about the potential

for mindfulness meditation to be challenging or triggering for students who have experienced

trauma. Furthermore, according to Himelstien, teachers can use a trauma-informed approach,

which recognizes a student’s behavior can be due to trauma and a need for self-protection (as

cited in Schwartz, 2019). These behaviors can include avoiding the activity, making noise

unnecessarily, making jokes, and not taking the activity seriously. Himelstein explained, “It’s

also important to realize that some of the ways mindfulness is practiced -- sitting still, eyes

closed, in silence -- can also be triggers for students who have experienced trauma” (as cited in

Schwartz, 2019, para.1). He advised against enforcing compliance with students, especially

around specific components such as closing one’s eyes. In addition, using more sensory-based

activities may be more helpful, such as counting breaths. Himelstein also explained that building

trust and forming a relationship with students are foundational to establishing a mindfulness

meditation program and practice. Himelstein stated, “Once those relationships are formed and

students trust their teachers, it’s more likely that mindfulness will be an effective tool for them”

(as cited in Schwartz, 2019, Trauma Sensitive Mindfulness section, para. 10). With such trust in

place, students may be more comfortable with attempting mindfulness meditations. When

students do act out during mindfulness meditation, it would be beneficial for the instructor to use


a trauma-informed approach to consider the source of such behaviors and adjust instruction by

removing triggering elements or increasing sensory components.

Mindfulness Training for Emotional Regulation

Learning to BREATHE is a program for middle and high school students to learn about

mindfulness topics and practices (Broderick & Frank, 2014). It is based on the Mindfulness-

based Stress Reduction (MBSR) program and modified to fit within the school day (Metz et al.,

2013). The BREATHE acronym in the program’s name spells out body, reflections, emotions,

attention, take it as it is, healthy habits of mind, emotional balance (Broderick & Jennings, 2012).

The program’s sessions include lecture, discussion, group activities, and mindfulness practices

centered around thinking, emotions, movement, and compassion (Metz et al., 2013). Students

are given workbooks and CDs for practice outside of class time. This study assessed the

program’s ability to improve students’ emotion regulation, levels of stress, and psychosomatic

symptoms (Metz et al., 2013).

The program consisted of students from two predominantly-Caucasian (90%) public high

schools within a middle-to-upper class suburb (Metz et al., 2013). All students from a choir

class participated with 129 in the training group, 87 in the control group, and an average of 25

students in each class (Metz et al., 2013). Training was led by the choir director, who received

eight weeks of training in the MBSR program along with a 2-day training prior to program start.

The trainer was observed and evaluated for program “fidelity” (p. 260) in every session.

Trainings were conducted for 15-25 minutes during choir class once a week such that there were

18 sessions in the span of 16 weeks (Metz et al., 2013).

The students were given a self-report survey to assess psychosomatic symptoms, stress,

and the ability to regulate emotions (Metz et al., 2013). They were also given a survey on their


opinion of the program with both closed rating questions and open-ended questions (Metz et al.,

2013). The pretest depicted moderate ratings for stress, emotional regulation challenges, and

psychosomatic symptoms. The post-test depicted an increased ability to regulate emotions,

greater emotional awareness, improved concentration, fewer psychosomatic symptoms, and less

irritability. When rating the program, 89% of the participants would recommend it, 7% were

uncertain or would conditionally recommend it to certain students, and 4% would not

recommend it. The most valued parts of the program were the body scan, sitting mindfulness

practice, mindful breathing practice, and mindful movement practice. Students rated other

program parts as moderately valuable: in-class presentation, group discussion, practice CDs, and

handouts (Metz et al., 2013).

In response to open-ended questions about what they found valuable about the program,

students answered as follows: 66% wrote that it taught ways to calm oneself, relax, relieve stress,

and breathe; 19% wrote that it taught ways to identify and accept emotions and ways for

emotional, cognitive, and behavioral regulation; 14% wrote that it taught them to be mindful of

the present moment, and 12% wrote about learning to concentrate (Metz et al., 2013). For the

open-ended question, one student wrote, “Before getting too upset or angry about a situation, I

am more able to see all sides of it and accept that it is okay” (Metz et al., 2013, p. 266). Another

student mentioned that “just closing your eyes, taking breaths, and listening to your body can

help you to relieve stress” (Metz et al., 2013, p. 266). Students provided insight into what they

found valuable about the program and how they used the material for stress management and

emotion regulation in their daily lives.


Mindfulness Meditation Group in Alternative High School

This program was conducted at an alternative learning center (ALC) for high school

students in a rural area of the United States (Wisner & Norton, 2013). In contrast to the previous

Learning to BREATHE program where a subset of the school was included in the program, all

36 students at the school were invited to participate in the program. One student declined, and

seven did not provide the full data needed, so there were 28 students who fully participated in the

program and data collection. Of the 28 participants, 27 were Caucasian and one was biracial.

Being predominantly Caucasian, this program’s demographic is similar to the Learning to

BREATHE program.

The program was conducted for eight weeks and led by a licensed mental health

practitioner experienced in meditation while the teacher sat in on the sessions (Wisner & Norton,

2013). The sessions included information on the benefits and challenges regarding meditation,

training in meditation techniques (i.e. posture, breath), as well as time for questions and

discussion. Students were led in two 4-minute meditations during the first two weeks and

progressed to one 10-minute meditation in the remaining five weeks (Wisner & Norton, 2013).

The students were also offered two additional 10-minute silent meditation sessions with staff

supervision, such that students had time to meditate in school four times each week. This

program offered sessions at a significantly greater frequency than the Learning to BREATHE

program.

Wisner and Norton (2013) used a pre-posttest method with a scale for teachers to rate the

emotional, social, and behavioral strengths of students. Using teacher input contrasts with the

Learning to BREATHE data which utilized student input. There post-test results depicted

significant improvements in all areas (Wisner & Norton, 2013). Wisner and Norton (2013)


concluded “the findings offer support for utilizing mindfulness meditation as an important

school-based group counseling intervention with the potential for improvements in psychosocial,

cognitive, and behavioral strengths for adolescents” (p. 218). Wisner and Norton (2013) found

these groups were beneficial for the alternative school population specifically, noting

“mindfulness meditation has the potential to be an effective and efficient intervention to use with

at-risk students, and can show positive results in a relatively short amount of time, in this case

only 8 weeks” (p. 219). This study demonstrated the usefulness and relevance of mindfulness

training within an alternative school.

Peer-Led Mindfulness Training with Adolescents

Peer-directed, Brief Mindfulness Training with Adolescents: A Pilot Study was intended

to evaluate the effectiveness of mindfulness training modified for adolescents (Jennings &

Jennings, 2013). It included eight European-American adolescents aged 17 to 18 years, as well

as a peer facilitator who led the sessions. None of the participants had previous mindfulness

training. Additional demographics or socioeconomic aspects were not specified. The

predominantly-Caucasian demographic is consistent with the two variations of the Learning to

BREATHE program. Jennings and Jennings (2013) described the peer facilitator’s preparation

to lead this program as the “peer facilitator received several hours of individual training in

mindfulness meditation with an experienced adult meditator to achieve basic competency” (p.

23). The researchers did not specify the number of hours of training or provide criteria for the

peer instructor’s competency in mindfulness meditation. The sessions were conducted during a

span of three weeks with each session lasting 50 minutes, making this the shortest of all

programs reviewed. Each session included a “counting breaths” practice and a guided sensory

meditation technique, all of which were obtained from the mindfulness training manual designed


by Apsche and Jennings for youth (as cited in Jennings & Jennings, 2013, p. 23). The practice of

following a manual is consistent with the Learning to BREATHE programs. Manuals support

the ability for a program’s practices to be implemented correctly and consistently despite having

differing instructors (Malik, Beutler, Alimohamed, & Gallagher-Thompson, 2003). Manuals

also help create a reliable structure and reasons for activities that can foster adolescent

participants’ acceptance and trust (Langer, McLeod, & Weisz, 2011).

Outcome measures utilized evidence-based pre-posttests for anxiety and social anxiety

(Jennings & Jennings, 2013). Using evidence-based scales is consistent with the Learning to

BREATHE program. Jennings and Jennings (2013) also collected unstructured written

qualitative data from participants at the last session. Results included anxiety scores that were

reduced by 30% and a 9% reduction in social anxiety scores. Qualitative data indicated several

participants appreciated the sensory guided meditations within settings such as the beach, the

mountains, and a rainstorm, and believed it was effective in engaging them in a meditative,

relaxing experience (Jennings & Jennings, 2013). One participant wrote, “I like mindfulness

because it’s a good way to relax and I feel like I have a completely different outlook on

everything afterwards. It makes me want to do different things than before the meditation”

(Jennings & Jennings, 2013, p. 24). This student’s answer demonstrated that mindfulness can be

useful for stress reduction and changing perspective and behavior. Another participant wrote, “I

really like mindful meditation. I like how it relaxes me and slows down my breathing and my

heart rate. It’s incredibly refreshing and I’ve looked forward to every meditation” (Jennings &

Jennings, 2013, p. 24). Obtaining qualitative data from program participants is valuable to

mitigate the potential for adults imposing their values, assumptions, interpretations on


participants’ experiences. In addition, researchers can use feedback to improve and further tailor

programs to the needs and interests of adolescent participants.

Mindfulness Groups for Latino Adolescents

The purpose of Effects of a Mindfulness Group on Latino Adolescent Students study was

to expand the multicultural perspective on mindfulness training for adolescents by focusing on

Latino adolescents aged 12-17 years old (Edwards et al., 2014). Edwards et al. (2014) cited

research studies comprised of a majority of Caucasian suburban adolescents to demonstrate there

is a significant under-representation of Latino students. Furthermore, Edwards et al. asserted

Latino youth face distinct stressors in addition to developmental challenges for their age. These

stressors can include complications to communication resulting from language barriers, cultural

disagreements among family members, additional responsibilities in caregiving for younger

siblings, and experiencing feelings of discrimination (Edwards et al., 2014). Cervantes and

Cordova reported Latino adolescents also face stresses from peers stemming from “drugs, gangs

and neighborhood violence” (as cited in Edwards et al., 2014, p. 146). Edwards et al. added

“financial, geographic, and cultural influences may limit many Latino students’ access to

psychological services” (p. 160). In response to Latino adolescents’ many challenges, Edwards

et al. (2014) proposed schools lead mindfulness groups as a way to mitigate these circumstances.

Participants were recruited for a stress reduction group from four schools from a rural

southwestern part of the U.S. (Edwards et al., 2014). Twenty Latino students completed the

study. Edwards et al. (2014) formed seven different groups over 15 months. Each group had

eight 50-minute sessions comprised of between two and six students. This program shared the

traits of being a separate group and having a small group size with the peer-led program. Similar

to the Learning to BREATHE and alternative high school programs, the groups were led by


psychologists, counselors, and a doctoral student, all experienced meditators and yoga

practitioners. Similar to other programs, this program followed a manual. In this case, the

sessions were based on the Biegel’s Mindfulness-Based Stress Reduction for Teens…MBSR–T

program (as cited in Edwards et al., 2014). Each session included “mindfulness practices such as

body scan meditation, sitting meditation, hatha yoga, and walking meditation” as well as

“didactic presentations, group sharing of related experience, and instruction in at-home

mindfulness practice assignments” (Edwards et al., 2014, p. 154). Participants were provided

written and audio instructional materials and instructed to practice mindful techniques outside of

group sessions for 25-30 minutes every day. Participants’ amount of meditation practice outside

of class was not described.

The program’s effectiveness was gauged by administering surveys to the participants that

measured mindfulness, stress, self-compassion, and psychological distress, such as anxiety,

depression, or hostility (Edwards et al., 2014). These surveys were administered two weeks

before the program began, at the beginning of the program, and eight weeks after the pretest

during the last session. Because these surveys were grounded in evidence-based scales, the

outcome measure methods share similarities with Learning to BREATHE and peer-led programs.

The results showed significant increases in mindfulness and self-compassion along with

decreases in stress and depression (Edwards et al., 2014). There were not significant levels of

reduction in participants’ anxiety and hostility scores. Edwards et al. (2014) concluded the

program’s instruction methods were effective and participants’ mindfulness increased from the

training, which may have led to reducing their feelings of stress. Consequently, Edwards et al.

(2014) concluded the program was successful and provided several reasons why a school-based

group mindfulness meditation is effective for Latino adolescents. Reasons included that it was


familiar, comfortable, and non-stigmatizing to be with peers at school and that it was congruent

with a collectivistic worldview (Edwards et al., 2014). Edwards et al. (2014) demonstrated a

knowledge of Latino culture and an ability to apply this knowledge to implement a successful

mindfulness meditation program.

Mindfulness Program at Park Middle School

Park Middle School in Antioch, California partnered with the Niroga Institute to create a

multi-faceted mindfulness program for the purposes of improving student emotional regulation

and decreasing teacher burnout (Coetsee, 2017). The principal stated,

Park Middle School had logged 255 suspensions by March 31 of the 2015-16 school year

-- a statistic that equates to 522 missed days of classes. By the same date in this

academic year there were 120 suspensions that accounted for 197 days of lost instruction

(Jimno, as cited by Coetsee, 2017, para. 24)

That change equated to a 53% reduction in suspensions in only one year. Furthermore, the

school board viewed the program as a success and approved funding to extend training and

implementation of this program to the elementary school level (Coetsee, 2014). This program

was the only one within this literature review to utilize behavioral data to contribute to outcome

measures. This program demonstrated how the use of behavioral data can illustrate success and

provide district leaders with a rationale for program expansion.

The mindfulness curriculum was delivered to the school’s student body of over 1,000

students through multiple channels, making this the largest program (Coetsee, 2014). This is

also the longest-running program since it is ongoing rather than finite (Coetsee, 2014). Unlike

other programs, the demographics were not specified. The principal used the announcement

system and enlisted the help of a student to ring a chime while he led the students through


breathing exercises (Coetsee, 2014). In addition, students spent “15 minutes in class twice a

week learning how to regulate their breathing, perform yoga movements and focus on the

present” (Coetsee, 2014, para. 7). This program is similar to the Learning to BREATHE

program, which also relied on classroom teachers to lead meditation instruction. The school staff

cited several applications and benefits for mindfulness training, including emotion regulation,

classroom behavior, academic performance, test anxiety, and calming down after gym class

(Petersen, as cited in Coetsee, 2014). The school cited both qualitative and behavioral data to

gauge the program’s effectiveness.

Using breathing techniques has been a core practice within this program. Petersen, who

is a teacher at Park Middle School, asserted this can help students learn much-needed coping

skills because “middle-schoolers often don't even fully understand why they're upset, much less

how to cope with their emotions" (as cited in Coetsee, 2014, para. 11). Petersen explained, “By

counting as they breathe in and out, they slow their heart rate and regain the focus needed to

figure out what triggered an outburst and how to avoid getting so worked up in the future” (as

cited in Coetsee, 2014, para. 12). Focusing on their breathing can help students relax, gain self-

understanding, and problem solve in a constructive manner. Bose, Niroga Institute’s Executive

Director, elaborated.

People breathe in different ways depending on their mood, and can change how they feel

by altering the way they inhale and exhale…By slowing his or her breathing, a person

can shift from anger to a more tranquil state of mind (as cited in Coetsee, 2014, para. 10)

In this way, students can use mindful breathing to manage their physical, emotional, and

behavioral symptoms of stress.


Mindfulness for Children from Lower Socioeconomic Backgrounds

The goal of this program was to offer mindfulness-based tools for children to cope with

stress and avoid detrimental mental habits that could “worsen stress and interfere with effective

problem solving” (Costello & Lawler, 2014, p. 26). In addition, Costello and Lawler intended to

gain insight into how children perceive and cope with stress. The program included 63 6th grade

students from two schools within lower socio-economic areas of Dublin, Ireland (Costello &

Lawler, 2014). The researchers focused on this demographic because Dore demonstrated

“children from families who experience greater levels of poverty are at increased risk of stress

and mental health problems compared with those in the general population” (as cited in Costello

& Lawler, 2014, p. 34).

Costello and Lawler (2014) met with the teachers who were selected to teach mindfulness

to explain the program and distribute the lessons to the teachers in a written script and a CD, so

they had a choice of lesson delivery format. The program included daily mindfulness meditation

lessons and practice for five weeks. The mindfulness meditation instruction focused on

breathing awareness and techniques, visualizations, awareness of the five senses, and body scans.

Practice started with a length of three minutes and increased gradually to 12 minutes during

lessons in the last week. While this program’s meditation practices were based on the MBSR

manual, it also incorporated other methods from unspecified sources (Costello & Lawler, 2014).

Costello and Lawler (2014) utilized both quantitative and qualitative data for the

program. For quantitative data, the students were administered surveys regarding their stress

before and after the program. The surveys were founded on evidence-based scales and included

10 questions on a 5-point Likert scale that measured the amount that participants perceived their

lives as stressful in terms of it being “unpredictable, uncontrollable, and overloaded within the


last month” (p. 26). Cohen et al. found those who scored 13 points had an average amount of

stress and those who scored 20 points or higher experienced a high amount of stress (as cited in

Costello & Lawler, 2014). The students in this program started with an average score of 18.12

and had an average score of 14.4 at the end of the program. For qualitative data, the children

wrote or drew about their experience after each mindfulness lesson. After the program, the

researchers conducted interviews with two teachers and 16 students (Costello & Lawler, 2014).

After reading the students’ post-training reflections, Costello and Lawler (2014) found

“the majority of pupils commented that they looked forward to the daily mindfulness practices,

which increased feelings of calmness and relaxation and consequently reduced perceived levels

of stress” (p. 34). Students also wrote about how they gained awareness of when they were

distracted by stress-related thoughts and responded by refocusing on their breath. Several

students wrote about how the program helped them with emotional regulation (Costello &

Lawler, 2014). Students described being happier, calmer, more relaxed, less irritable, and

recovered from angry feelings faster (Costello & Lawler, 2014). For example, participants

wrote: “I felt irritated at first, but now I feel calmer,” “I like doing breathing when I feel

nervous, irritated and angry,” “I felt cool and collected when I was breathing,” and “the

breathing exercise really calms you if you’re feeling down” (Costello & Lawler, 2014, p. 29).

Students also realized they experienced an increased awareness and objectivity towards their

negative thought patterns. As one student explained, “things have become much clearer and

before getting too upset or angry about a situation, I am more able to see all sides of it and accept

that it is okay” (Metz et al., 2013, p. 266). Another student stated, “I learned that I can control

the way I react to things and that nothing is too overwhelming for me to handle” (Broderick &

Frank, 2014, p. 33). Furthermore, nearly 40% of students stated they used mindfulness-based


techniques to detach from their stressful thoughts and increase relaxation (Costello & Lawler,

2014). The participants’ journals depicted students’ improved awareness, emotion regulation,

and stress management as a result of mindfulness meditation lessons.

After interviewing students and teachers, Costello and Lawler (2014) also realized that

the mindfulness meditation program helped several students with stress management and

behavior at school. Costello and Lawler (2014) stated “many gave recounts, which illustrate

abilities to pause and be more reflective about how they react in certain stressful situations” (p.

33). Participants’ increased relaxation and reduced tension improved their capacity for learning.

For example, a student explained, “I think mindfulness is very helpful. It helps me feel calmer

and concentrate better” and another student said mindfulness “helps me calm down and do my

work” (Lamb, 2017, p. 4). Students stated they used mindfulness meditations to cope with test

anxiety and the frustration they experienced after getting an answer wrong (Costello & Lawler,

2014). Other students anticipated they would use mindfulness to cope with stress of

transitioning to secondary school. Students noticed that mindfulness positively influenced their

behavior and helped them to “stay out of trouble” (Costello & Lawler, 2014, p. 31). One student

provided a situation in which mindful breathing was useful, “I’ve actually practiced it the other

day. I was about to get in an argument.…I took three breaths ...and took three more breaths.

And I was actually calm and left the argument” (Sibinga et al., 2011, p. 216). Teachers also

noticed improved behavior. Costello and Lawler (2014) relayed, “One of the teachers also

observed a reduction in reactiveness and disruptive behavior following the mindfulness

intervention” (p. 31). According to both students and teachers, the mindfulness program helped

students react to stress in more constructive ways.


Despite the significant positive results, Costello and Lawler (2014) provided a cautious

conclusion. While the mindfulness meditation program had beneficial effects for most of the

participants, Costello and Lawler (2014) noticed that it could have a detrimental effect for some

students. Some participants felt that mindfulness was ineffective for stress management,

stimulated stress, or instigated feelings of sadness (Costello & Lawler, 2014). For example, one

student stated, “I tried to clear my mind but I’m still worried… my head is filled with lots of

things. It’s like I’m holding two big pots filled with hundreds of heavy things” (Costello &

Lawler, 2014, p. 30). Another student “was sometimes upset by thoughts and feeling which

arose during mindfulness, she felt she gained awareness and understanding of her sad feelings”

(Costello & Lawler, 2014, p. 34). Costello and Lawler hypothesized these students were

“experiencing initially greater levels of stress and subsequently reacted more negatively” (p. 34).

Despite these challenges, all participants continued with the program. This finding led

researchers to two conclusions. First, it “demonstrates the need for caution when introducing

mindfulness, as it may not be suitable for all children” and “further consideration is therefore

needed regarding possible resistance to mindfulness and maladaptive feelings following

mindfulness practices” (Costello & Lawler, 2014, p. 34). Second, that “further research is

needed to examine why some children may respond differently to mindfulness” (Costello &

Lawler, 2014, p. 33) has not been addressed in previous studies. Overall, Costello and Lawler

(2014) suggested mindfulness meditation programs could be implemented to help teach “social

and emotional skills, including self-awareness, the ability to manage emotions, optimism,

persistence and resilience, all of which are outcomes of mindfulness” (p. 35). Overall, Costello

and Lawler (2014) saw that teaching mindfulness meditation to students was an effective method

for stress management and emotional regulation.


The Adlerian Individual Psychology Perspective

The Nature and Purpose of Emotions

Adler stressed the subjective nature of emotions when he stated, “Our emotions do not

stem from events, but from our interpretation of these events” (as cited in Dewey, 1984, p. 194).

Placing the cause of emotions intrinsically with our interpretations enables us to be in control of

our experiences of them. Furthermore, “Adlerians view both feelings and actions as subservient

to thoughts” (Dewey, 1984, p. 185). Consequently, we can change our emotions by changing

our thoughts. This capability is demonstrated by a classic Adlerian tool known as the pushbutton

technique, whereby the therapist instructs the client to relive a pleasant experience and notice the

corresponding pleasant feelings that arise (Mosak, 1985). Next, the client is instructed to relive

an unpleasant experience and notice the corresponding negative feelings. Finally, the client is

prompted to relive the first pleasant experience again along with the corresponding feelings.

According to Mosak, the therapist can use this technique to illustrate that the client “can create

whatever feelings he wishes merely by deciding what he will think…he is the creator, not the

victim, of his emotions” (as cited in Dewey, 1984, p. 194). The dominance of thoughts over

emotions can empower people to deliberately choose more constructive thoughts to foster

emotion regulation.

Adler believed emotions served a purpose, and their purpose could be generally

categorized as either beneficial or detrimental (as cited in Dewey, 1984). On the beneficial side,

Adler categorized emotions as “socially conjunctive” such that they brought people closer

together (as cited in Manaster, Cleland, & Brooks, 2003, p. 244). Adler distinguished “joy,

sympathy, and modesty” as being conjunctive (as cited in Dewey, 1984, p. 185). Adler also

believed emotions served several beneficial purposes. For example, nervousness could inspire us


to be better prepared for a performance, fear could cause us to flee from a dangerous situation,

anger could inspire us to overcome obstacles, hurt could inspire us to volunteer for a cause or

deepen our empathy for others (as cited in Dewey, 1984). In these ways, emotions are beneficial

because they are an impetus to positive, healthy actions. On the detrimental side, Adler

categorized emotions as being “socially disjunctive” such that they served the purpose of

creating further distance between people (as cited in Manaster et al., 2003, p. 244). Adler

distinguished “anger, sadness, disgust, fear, and anxiety” as being disjunctive (as cited in Dewey,

1984, p. 185). Adler believed people tended to misuse emotions when they were denied

something or when the dominance of their personality was threatened (as cited in Dewey, 1984,

p. 185). Adler asserted that emotions are “misused to get special service, to control or

overwhelm others, to excuse us from functioning normally, to provide an excuse to retaliate

against others, or to serve as a license for poor behavior” (as cited in Dewey, 1984, p. 184).

These are examples of emotions being used for non-constructive ends, such as gaining power or

avoiding responsibility.

Adlerian View of Confidence

Preventive medicine, especially for children, was an important topic for Adler

(Ansbacher, 1992). He advocated for a proactive approach to fostering positive mental health in

children and believed that developing self-confidence and self-sufficiency were the keys. Adler

described a self-confident person as one who “feels at home in the world and confident to be able

to cope with the life tasks” (as cited in Ansbacher, 1992, p. 12). Self-confidence supports the

capability to manage one’s responsibilities and challenges. Adler (as cited in Williams, 1990)

asserted the primary foundation for a child’s development is trusting his or her own capability

because “the self-confidence of the child and his personal courage are his greatest fortune.


Courageous children will later in life not expect their fate to be directed by some outside force,

but from their own power” (pp. 62-63). Adler believed a child’s most important asset was

confidence and self-sufficiency so she can define and forge her own life path rather than feeling

a victim of external circumstance and using them as excuses to avoid responsibilities.

As Adler viewed confidence as foundational to mental health, he viewed the lack of

confidence as foundational to dysfunctional mental processes and mental illness. Adler asserted

“mental disorder is characterized by strong inferiority feelings” (as cited in Ansbacher, 1992, p.

12). Inferiority feelings can be defined as “feelings of incompleteness, smallness, weakness,

ignorance, and dependency” (Griffith & Powers, 2007, p. 60). Another term commonly used in

Adlerian Individual Psychology is felt minus, which is defined as “universally-experienced

inferiority feelings of incompleteness, of being below, of being in a position of ‘less than’ the

others, or less than what life requires or allows” (Griffith & Powers, 2007, p. 39). Adler believed

these feelings to be universal because they originated from the experience of being a helpless

infant (and continued as a child) who was incompetent in comparison to his or her parents (as

cited in Griffith & Powers, 2007). Just like all other emotions, inferiority feelings can be

beneficial because they can “serve as spurs to effort and as a source of motivation to overcome

obstacles, to grow, to improve oneself and the community” (Griffith & Powers, 2007, p. 60).

Adlerians say that the person is “striving for superiority” over their inferiority feelings and that

“inferiority mobilizes the patient's inner push to go from a minus to a plus” (Smith, 2009, p.

241). A felt plus can be defined as an “image of maturity, mastery, completion, fulfillment, or

perfection which the individual strives to attain in his or her struggle to move away from the felt

minus situation toward the fictional plus personality ideal” (Griffith & Powers, 2007, p. 39).


While Adlerians recognize the potential for inferiority feelings to be detrimental, they also see

these feelings as universal and having the potential to be a beneficial motivating force.

Inferiority feelings and striving for superiority can also be detrimental. Adler (1928)

realized the feeling of inferiority was generally regarded as a sign of weakness and as something

shameful; therefore, there is a strong tendency to conceal it. Adler believed people often try to

eliminate feelings of inferiority through a stance of “safeguarding,” which can be defined as

“hidden or unacknowledged…cowardice or retreat of the unprepared person, whose confidence

in the face of an imperative task is shaken by thoughts of possible failure...the safeguard protects

a pretense of superiority…in addressing life’s ordinary challenges” (as cited in Griffith &

Powers, 2007, p. 89). One method of safeguarding is striving for superiority, including “striving

for superiority through power over others” (Smith, 2009, p. 245). This approach to striving for

superiority is a detrimental way to assuage feelings of inferiority.

Adolescence, inferiority feelings, safeguarding, and striving. According to Adlerian

concepts, adolescents can choose how they perceive and respond to situations. Their perceptions

then determine their emotions and stress levels. Furthermore, “the particular manner in which

the individual student creates her perspective and proclivities is mediated by the types of

regulatory mechanisms that that student uses to navigate within the schooling environment”

(Lemberger & Krauss, 2013, p. 87); therefore, how a student perceives events and self-regulates

is considered an aspect of his or her approach to striving. Lemberger and Krauss (2013)

asserted, “In a school setting, striving might include how a student experiences new information,

responds to internal and external obstacles, or develops stratagems to pursue goal completion”

(p. 86). For example, striving occurs when learning new material, preparing for and taking tests

or working on projects, relating with staff and peers, and participating in extra-curricular


activities. A student feeling challenged and stressed in school could “lead to inferiority feelings

and compensation in detrimental ways” (Ansbacher, 1992, p. 13) such as “striving for superiority

through power over others” (Smith, 2009, p. 242). For example, a student’s striving for

superiority could manifest through bullying or engaging in power struggles with teachers (Mosak

& Maniacci, 2006; Rasmussens & Dover, 2006; Waller, Carlson & Englar-Carlson, 2006).

Furthermore, Hoffman, Cole, Martin, Tram, and Seroczynski explained adolescents’ natural

tendency towards negative self-appraisal and heightened threat sensitivity could easily lead to

lowered self-confidence, a fear of failure, and feelings of inferiority (as cited in Lanteigne et al.,

2014).

Similarly, there are aspects of safeguarding that are pertinent to adolescents and their

developmental stage. Adler referred to safeguarding when “addressing life’s ordinary

challenges,” which, in fact, are not ordinary when encountering them for the first time and

learning how to address them (as cited in Griffith & Powers, 2007, p. 89). Likewise, Adler

stated that safeguarding was used by the “unprepared person” (as cited in Griffith & Powers,

2007, p. 89). Again, adolescents are encountering such a large number of new events and issues

during this time that it would be natural for them to be “unprepared.” Furthermore, learning

through school, friends, or family may not be adequate preparation when a student experiences

the issue or situation for him or herself. For example, experiencing puberty or beginning to drive

a car are likely to create potential confusion and follow-up questions even after health education

classes and training to prepare for a driver’s permit.

Mindfulness Within the Context of Individual Psychology

Mindfulness can be used in conjunction with Adlerian concepts to support emotion

regulation and stress management. Mindfulness can be used to objectively view and identify


one’s thoughts and emotions in response to events, consider whether or not the responses are

constructive, and deliberately choose more constructive responses. One can identify if his or her

feelings are having a conjunctive or disjunctive effect. Furthermore, mindfulness can be used to

pause before acting on one’s feelings. This pause can be especially useful if one is considering

striving for superiority in a detrimental way and consider how to strive in a more constructive

manner. Mindfulness is also supportive of building what Adler referred to as psychological

tolerance, which Ansbacher and Ansbacher defined as “the amount of subjective threat a person

will bear without safeguarding himself or herself in a situation” (as cited in Slavik & Croake,

2006, p. 420). Psychological tolerance is an indication of one's willingness to stay with and

work with changes in life as they present themselves. Ansbacher and Ansbacher noted how

Adler identified psychological tolerance as a mitigating force against unhealthy striving for

superiority (as cited in Slavik & Croake, 2006). Conversely, “an individual with low

psychological tolerance becomes wary of expected events and sees threat to esteem where others

may not” (Slavik & Croake, 2006, p. 420). Low psychological tolerance can lead to one

assuming that an event will create feelings of inferiority. Consequently, “in exaggerated

responses to anticipated occurrences, one may aid in creating negative and aversive events”

(Slavik & Croake, 2006, p. 420). Furthermore, these assumptions can lead one to react in

detrimental ways; however, mindfulness can help build one’s psychological tolerance for

feelings of inferiority and mitigate the tendency to strive for superiority in an unhealthy manner

(Waller et al., 2006). For example, mindfulness can be a tool to cope with the uncomfortable

feelings of inferiority by remembering their transient nature. One could also use mindfulness to

realize that he or she is experiencing negative emotions and use the pushbutton technique to

bring oneself back into a more positive state. In these ways, adolescents could use mindfulness


to cope with feelings of inferiority and build psychological tolerance, which, in turn, builds

feelings of confidence and independence. Adolescents realize that they can regulate their own

emotions without being helped or soothed by adults. Building adolescents’ self-sufficiency is

congruent with their developmental stage and needs for increasing independence.

Discussion

Implications for Practice

The research findings offer implications for practice in three main areas: mindfulness

instructor training, conducting a mindfulness program, and data. To begin, consider the contents

of the mindfulness instructor training and potential topics in which to expand content. For

example, information could be added to increase awareness of how mindfulness meditation can

affect students with a history of trauma, including signs that a student is being triggered (e.g.

avoidance, making jokes, or disruptiveness), and ways to avoid and mitigate triggering effects

for students with trauma. Training could also be augmented with information about the breath,

such as sighing, diaphragmatic breathing, and how it is closely related to emotions. Another

topic to include is multicultural awareness of how different cultures perceive, value, and

participate in meditation. With this knowledge, the leader can explore ways to modify program

content and activities to be more inclusive of the participants’ cultures.

There are implications for conducting the group mindfulness program as well. First, the

programs that were reviewed demonstrated there are several viable options for delivering the

program, such as through a loudspeaker, teachers, peers, recordings, or a mixture of these

delivery methods. Second, adapt mindfulness instruction and content to fit adolescents’

developmental stage, such as using shorter, more sense-oriented mindfulness instructions and

exercises. Third, the instructor should watch for signs that a student with trauma is being


triggered and be able to work with him or her. Fourth, include instruction on belly breathing,

breathing pace, and the connection between breath and emotions. Furthermore, during the

breathing practices, the instructor should observe students’ breathing, such as watching for belly

breathing, sighing, and an appropriate pace. If there is a significant amount of sighing, the

instructor may need to clarify instructions or simplify or shorten the practice, or switch to a

different practice. The instructor could observe the overall sighing frequency both within each

session and over the program. Ideally, the sighing would reduce during both of these

timeframes.

The research also highlights the importance of collecting data. Ideally, mindfulness

instructors would adopt a more scientific, methodical, research-oriented approach to collecting

data. For example, it is informative to conduct surveys and inventories before and after the

individual sessions and overall program. Furthermore, it is useful to collect multiple types of

data such as self-report inventories and surveys, behavioral data and teacher feedback because

they can be used to verify one against the other (Edwards et al., 2014). Likewise, it is edifying to

collect both qualitative data, including open-ended questions, and quantitative data, especially

evidence-based inventories for stress, emotional state, or mental health, such as the Beck Anxiety

Inventory. In addition, research rarely includes detailed information about the breathing

techniques used by the subjects; therefore, researchers would be making important contributions

by collecting specific information such as details of the breathing patterns the students used, how

closely the students adhered to instructions, and the perceived effectiveness and effort of the

techniques.


Recommendations for Future Research

This literature review illustrated insufficiently-researched topics and populations that

could be addressed through future research. For example, researchers could learn more about

how various cultures view mindfulness, meditation, and the breath, then adapt the mindfulness

program to accommodate those cultures and conduct programs with a majority of participants

from those cultures. Similarly, researchers could learn more about which mindfulness

meditation practices would best serve students with trauma, and conversely, which practices to

avoid, and how to soothe students who have been triggered during the program. In addition,

researchers could explore the effectiveness of various mindfulness instructor qualifications and

characteristics. They could also publish more information about the instructor training

curriculum and gather feedback on the training program from instructor trainees.

This literature review also highlighted gaps in research about breathing. Programs

commonly mix multiple mindfulness methods such as guided meditation, breathing practices,

and yoga. This makes it difficult to determine the effectiveness of any single practice. As noted

by Paulus (2013), there is still much to learn about the connection between breath and emotions;

therefore, research is needed to create and conduct programs that focus on breathing practices to

the exclusion of other practices to better determine the true benefits of breathing practices.

Furthermore, researchers rarely included specific details on the breathing techniques used such

as diaphragmic breathing, breathing rate, and use of the nose or mouth to inhale or exhale.

While there is research that includes these details about breathing, it is written for an audience of

highly specialized professionals such as neurophysiologists. This research includes a level of

detail and assumes a level of knowledge far beyond what would be accessible to a more

pragmatically-oriented reader; therefore, this research needs to be disseminated to practitioners


in a more simplified manner. Likewise, educators and mindfulness instructors should

disseminate their findings both to other practitioners and to researchers to further both pragmatic

and scientific knowledge and cross-disciplinary collaboration. Finally, considering Adler’s

understanding of the interconnection between mind, emotions, and body, it was surprising to find

database searches for the Adlerian Individual Psychology view of the breath yielded nothing.

Individual Psychology scholars and practitioners should contribute publications on their

understanding of the connection between breath, emotions, and Adlerian concepts.

Conclusion

Adolescence is typically a time of greater responsibility, stress, and negativity, which is

exacerbated by inconsistent physiological developments that can lead to difficulty managing

emotions. Experiencing stress and recurrent negative emotions can detrimentally affect

adolescents’ health and academic performance. Given the mercurial emotions adolescents can

experience, emotion regulation and stress management become important assets for coping,

health, and functioning during adolescence. Mindfulness and mindful breathing have been

demonstrated to be effective methods for stress management and emotion regulation.

An exploration of Adlerian concepts can help explain how mindfulness may be useful for

adolescent emotion regulation and stress management. Adlerian theorists asserted adolescents

can choose how they perceive and respond to situations. Since these perceptions then determine

adolescents’ stress levels and emotions, mindfulness can be used to cope with uncomfortable

feelings and to deliberately choose more constructive responses. Adolescents discover they can

regulate their own emotions without being helped or soothed by adults. This capability builds

adolescents’ self-sufficiency and confidence, which aligns with Adler’s belief that these traits

were crucial elements for mental health, resilience, and responsibility.


Group mindfulness training programs for adolescents have been successfully

implemented in a school setting in a variety of formats. These programs differed according to

the instructional delivery mode, level of mindfulness instructors’ qualifications, amount of

program participants, program length, and the socioeconomic qualities of the communities in

which they resided. By reviewing these programs, one can see two points. First, group

mindfulness training is an effective method for teaching adolescents skills to help them manage

their emotions, behavior, and stress. Second, school administrators and staff have options for

how to implement a group mindfulness program so that it is fitting for the school schedule, staff

qualifications, and community.


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